Via KevinMD: This issue has come up before, most recently when the New England Journal of Medicine asked whether doctors should friend their patients on Facebook.

Pediatrician Bryan Vartabedian looks further at the issue, and sees it fraught with potential risk.

He points out that sharing privileged information requires written consent. But what if the patient initiates the conversation? Some attorneys say that can imply consent, but the laws in this area are not yet clear.

Also, every communication between doctor and patient needs to be documented. Dr. Vartabedian notes that “the documentation on most social platforms isn’t detailed enough for other medical professionals or auditors to follow what’s gone on between you and your caregiver [and] let’s not forget that Twitter has a habit of disappearing after a couple of weeks.”

And perhaps most concerning is the privacy issue. When someone shares personal medical information in a public forum, like Twitter or a Facebook page, it has to potential to get indexed by search engines, making it permanent on the web.

There’s tremendous potential for doctors to better use Twitter and Facebook to interact with patients. By guiding patients to reputable sources of medical information, for instance.

But social media isn’t mature enough for doctors to provide personal medical advice to patients. Yet.

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The following is from a string of emails that were circulating among some of Medical Spa MDs Members. I’ve edited this somewhat to make it readable and get rid of all the extraneous copies. I’m also not displaying the identity or email addresses of the physicians in this thread.

Note: Some of the comments below might be out of order from the original thread. Emails’ somewhat difficult to follow as a thread but you’ll get the gist.

Thanks for the filler tips.Can you explain how you get the Lido with epi mixed into the Juvederm syringe? –PD

Hi Jeff,–I agree w/ #6.  I seem to get good augmentation, less redness, swelling and bruising with Evolence.  I use it for deeper fills in cheeks, NLF, etc.  Don’t use it for lips or under eyes.  I do same with Lido w/ epi.  I tend to use Juvederm in lips.  Perlane / Restylane for other areas.  I agree w/ why Allergan uses 0.8 cc syringes. I’ve moved away from Radiesse.  I feel that the duration is not that much longer than a good correction with the HA’s.  Besides, I believe a fair amount of the volume of Radiesse is a gel carrier, thus needing touch-ups at 2-3 months.  Perhaps that’s why the went to the larger syringes? — Don

The push ahead technique also moves small blood vessels out of the way, so you may notice less ecchymosis is overall pts. — Greg

I would not use push ahead around the eye, I agree with Tom’s comments. It works great for NLF. I was actually taught this by a PS — Greg

Interesting discussion.  So Kevin, how do you account for the difference in that anterograde injection you need less filler than in retrograde injections, assuming all else being equal?

Second, I am understanding one group claims anterograde injection carries a higher risk of vessel cannulation and possible intravascular injection, while another group claims that anterograde injection “pushes away” blood vessels, thus decreasing the risk. Not sure how anterograde increases risk of intravascular injection any more than retrograde.  If you push the needle ahead, transfixing a vessel, then begin injection, you can still conceivably deposit some material intravascularly, can you not?  Am I missing something here?

I also found an interesting idea of sub q bolus technique in areas of thin skin, ie crowsfeet, etc.  Anyone else try this method? ~ Don

I do agree with you about those risks with anterograde injection. The key is always the skills in doing it, be it retrograde or anterograde. One always has to be very carefully doing anything around the eyes. However, the anterograde techinique has been advocated some of the best known experts such as Arnold Klein, MD and Kent Remington, MD. I also believed that the filler amount used was critical. It takes much more amount to get the same result with the often taught retrograde technique compared with the anterograde one. For example, I almost never required more than one full syringe in correcting bilateral NLF’s vs what was typically used ( 2 syringes) by most others. I attached the before and after of a case wherein I used Readiesse to correct her NLF’s and Marrionette’s lines with anterograde technique. The after photo was taken right after. You can still see some of needle marks. I used one full 1.3 cc syringe, 1/2inch 30g for the Vermillion border and 1/2inch for NLF’s and Marrionette’s line. Notice also there was no “puffy/swollen look” medial to the Marrionette’s line often seen with retrograde and fanning technique used by most others. ~ Kevin

I came across this old thread way down in my inbox and read it again.  I’m not sure who wrote #4 below.  It sounds interesting but I’m having a hard time visualizing it.  Do you steadily move the needle forward  toward the lip edge as you are injecting or do you hold it in place while the area fills?  I’d love to see a drawing on where you start.  ~ SD

Something worth knowing. How is your plastic surgeon or dermatologist communicating with other physicians to keep abreast of the latest information about treatments?

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Contrary to popular belief, very few medical malpractice cases involve doctors and Botox cosmetic.

The prevailing idea is similar to what a respected icon in the makeup industry opines: Women should be afraid of Botox. Her reason: because it involves injecting poison into your skin.

I’d be rich if I got a penny for every single time I’ve read and heard this statement. Here’s the important truth that you, our dear reader, should remember. Botox cosmetic, administered in the proper dosages by an experienced injector, is safe.

Firstly, Botox is not injected to the skin but into the muscle underneath. Its purpose is to calm the muscle, giving the skin a break from repetitive creasing which, in the long run, allows it to return to its taut state. When the skin is allowed to smoothen out and tighten up, your wrinkles become less visible and eventually disappear.

Secondly, Botox is not scary. In fact, even the FDA acknowledges that most common side effects associated with the drug’s cosmetic use is ptosis or drooping of the eyelid.

Yes, there have been several reports linking Botox to paralysis and death but those instances are not from the cosmetic use of the drug.

The FDA’s Postmarket Drug Safety Information has the following information:

Adverse effects for pediatric cases are reported to come from treatments of muscle spasticity in cerebral palsy.

For adult cases, migration or distant spread of toxin effects are reported to come from treatment of spasticity and cervical dystonia. The report also stated that the several deaths connected with the use of the drug cannot be attributable to the toxin itself but to complications of pre-existing conditions.

With regard to the cosmetic use of the toxin, the FDA categorically stated, and I quote, “…there have been reports where some symptoms could be consistent with distant spread of toxin effect following dermatologic use.  However, no definitive serious adverse event reports of distant spread of toxin effect associated with dermatologic use of Botox at the labeled dose of 20 Units (for glabellar lines) or 100 Units (for severe primary axillary hyperhidrosis) have been identified”.

Even with this current track record, doctors are careful with injecting the toxin to the lower part of the face to treat smile or marionette lines. There’s a world of difference between causing droopy eyelids and paralysing somebody’s lips disabling them from speaking. The first only pertains to appearance, the other can affect one’s life and work. Doctors know this so, some of them refrain from performing these treatments. In any case, the effects of Botox cosmetic, both the good and the bad, are only temporary. As such, things return to the way they were after a period of time.

We don’t have any legal authority to say that a malpractice case becomes moot after things return to normal. But at the very least, people should consider the fact that there are few medical malpractice cases involving Botox as a sort of reassurance. Doctors take care of their patients and their reputations and would not intentionally cause harm to clients. Add this to the fact that the drug itself is safe, and you end up with something that should not be feared.

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Skin cancer is the most commonly diagnosed cancer in the U.S. The reality is, more than one million individuals are told they have basal cell or squamous cell (non-melanoma) carcinoma annually. Presented with these considerable statistics, every person will likely know someone who may have had a skin cancer burned out. Even so, basal cell carcinoma and squamous cell carcinoma are often slow growing and most often not deadly. For instance, fewer than one thousand people die from non-melanoma skin cancer every year.

While proper diagnosis of any sort of skin cancer is problematic which individuals refer to it generically as “C,” most individuals interviewed were a whole lot more intrepid about a skin cancer treatment. Their emotions aren’t going to be on radiation or chemo. There may be factors why people don’t take epidermis cancer so seriously. For one, the two nearly all well known sorts of skin cancer are primarily not fatal.

The Melanoma version of skin cancer is what you really do need to concern yourself with and why you need to seek out dermatologists, who’re taught to identify all sorts of skin cancer. Your local laser clinic or medical center is a good place to start with this…. anywhere that you can find a competent MD.

Almost all new research calculate that 68,720 brand new examples of melanoma may have recently been diagnosed in 2009. This is less in comparison with breast cancer , colon cancer (106,100) and lung cancer (219,440). There is however one particular noticeable differentiation.

We’ve got the various tools required (your eyes plus a hand mirror) to pick up on possible problem areas. Our follow-up with a health-care professional each year will be able to make sure the malignancy is eliminated, before it propagates to your lymph nodes.

The good thing is once melanoma is found early on, it’s extremely treatable, bragging 90 percent and above success rates.

Then again, malignant melanoma, if found later on, may be a cancer with only a few effectual procedures. The typical number of people who will be told they have an advanced stage of melanoma do not live a whole year according to the Melanoma Research Foundation.

Even though there are those who say ignorance is bliss; burying your head in the sand may very well kill.

The main thing you may do, if you happen to have got just about any question, is go and get it tested. The last thing one wants to do is to lose your life by a problem you have been considering.

No related posts.

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Creases and facial lines are an almost universal side-effect of the aging process. Occasionally they disclose one’s actual age, but yet sometimes they can make a person seem to be more aged than they actually are, exacerbated by sun and weather damage, cigarette smoking, and bad nourishment.

In time, our skin becomes not as elastic and effective holding onto moisture, while the deepest layers of skin shed fat cells, which sometimes bring sagging and wrinkles at the surface of the skin.

There’s a lot of solutions for getting rid of and minimizing fine lines , including Botox, dermal fillers, laser skin resurfacing, and topical chemical peels and creams. If ever the wrinkles and fine lines aren’t too deep or excessive, it may be possible to remedy them employing a glycolic acid peel, a lactic acid peel, or a glycolic peel.

A Glycolic peel works by stimulating collagen under the epidermis. It’s really a really light peel that is going to be used every fourteen days, over time causing up to a 20% thickening of the skin.

Excellent for fine lines, eye wrinkles and smile lines, glycolic acid can’t help with sagging skin or serious wrinkles.

An alternate procedure for fighting wrinkles is by using lactic acid. Unlike glycolic acid, it functions entirely on the surface layers of the skin, by pulling moisture content into skin cells.

Glycolic chemical peels may be used once every week. For best results, anyone using it should always exfoliate and hydrate their skin on non-treatment days.

With all the previously mentioned products, it is recommended that users should avoid using self-tanning creams, facial hair waxing, masks, scrubs, or exfoliants for 48 hrs prior to a peel. Additionally, limit sun exposure and tanning for not less than 7 days prior to applying the peel.

After the peel, just a few basic guidelines can help ensure the best results. Don’t workout or sweat excessively for a couple hours after use, and don’t use exfoliants until the facial skin returns to its usual condition. In addition, make sure you apply a fragrance-free moisturizer 2 times a day.

For anyone who is thinking about learning what cosmetic surgeons and various medical professionals operating nonsurgical cosmetic medical spas think of the next Intense pulsed light (IPL) and skin fractionated laser technology choices out of Sciton, Candela, Alma, Cutera, Cynosure, Lumenis, Solta, Syneron, Palomar and others, as well as skin treatments such as Thermage skin tightening, Slimlipo, Botox, mesotherapy and photofacials, remember to view all the cosmetic skin laser discussions on Medical Spa MD, a online community of medical doctors practicing aesthetic medicine.

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According to the American Society for Plastic Surgery, you don’t have to be a medical doctor or even a trained medical professional to open a medical spa. In fact, many medical spas are now administering serious procedures such as botox without a doctor present on staff. As a result of the lack of regulation throughout the country in the developing medical spa industry, there is a rapidly growing list of complaints throughout the country for serious incidences such as burns and scars. Most experts agree that you should not visit any medical spa that doesn’t have a doctor on staff supervising all procedures.

Here are some questions you should ask when visiting a medical spa.

1. Who is the doctor and where was he/she trained?
2. Will the doctor be performing my procedure?
3. If the doctor is not performing my procedure, will he/she supervise the procedure?
4. If the doctor is not doing the procedure, how experienced is the person that is doing my procedure and how many procedures have they performed?
5. Does the spa own or rent its machines? Most experts agree that there is less risk to the patient if the spa owns its machine.

Many experts have also told us to avoid spas in which the prices are too cheap. Botox is priced at $500 per bottle for every buyer.

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